One other consideration that will not be uniform among LDC's is the extent to which efficiency can be achieved by simply incorporating the administrative and service responsibilities for family planning into existing maternal and child health programs. Ideally, family planning services should be incorporated into maternal and child health services. However, it appears that most maternal and child health programs still have far to go in achieving their prime objectives of basic maternity, infant, and child care. Not only can few economies be achieved, but also a new and controversial service like family planning is unlikely to be introduced effectively if administered as a new objective of maternal and child health. In any case, family planning program costs should be considered as new and additional to other health services in almost all LDC's during the next 20 years. Experience also suggests that, as in the case of malaria eradication, national administration of new family planning programs requires a high and semi-autonomous status in the bureaucracy. In the long run, to the extent that contraceptive technology requires health services, family planning should be incorporated with other family health services. Provisions for such an eventual merger should be part of the planning and implementation of family planning programs from the start.
Reduction in Natality from Family Planning
The effect of family planning services upon natality in the LDC's in the next 20 years will depend mainly upon three factors: the extent to which effective birth control information and services are made readily available to the people; the extent to which natality is modified by means other than birth control (for example, raising the age of marriage); and the extent to which the public wants to use birth control or other means—in other words, how much public attitudes change regarding desired family size and child spacing.
During the next 20 years significant changes in contraceptive practice are more likely than significant changes in age of marriage or the proportion of persons who marry. Contraception involves lesser modifications of agricultural village life, and governments will probably have more effective methods to promote birth control than to change marriage patterns.
In the absence of adequate natality registration in most LDC's, evidence for the effect of family planning programs on natality rests primarily on two propositions:
1. A certain proportion of families of reproductive age use specified methods of family planning provided by the program and not otherwise available or likely to be used.
2. Enough is known of the length of use of different methods of family planning and of the fertility and other characteristics of families using and